Before and After: Reconstructive


I have recently passed the 1000 cases mark of free reconstructive surgery on burned and disfigured children from Cambodia and Vietnam. Here are a few. (Most of the cases are little girls.  I choose not to show them here as it is too upsetting…)
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Always start with the mouth and work out. The mouth is the most important facial feature by far. (Not the eyes).
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 Eam age 15

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After I had injected her eye with lidocaine, she got scared and asked for her mom. Her mom came into the operating room… She told us the little girl didn’t want to go through with it any more
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Fifteen minutes later in the consultation room…‘’Maybe it’s a good idea that we aren’t going to do this’’, I told her. ‘’Why?’’ she sobbed. ‘’If we fixed your eye, all those boys at school are going to start chasing you. All those boys, those boyfriends, all those boys won’t leave you alone… the boys… They’ll be wanting to talk to you and chase …
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The prosthesis didn’t fit at first (see her right eye swelling) and kept falling out (because the company in China sent us the wrong size!). We didn’t have a file so I had to use the concrete sidewalk in front of our clinic at the Cambodiana Hotel to ‘’sand it down’’ so it would fit. Three trips to the sidewalk and it was a perfect fit. I included this story in my book: ‘’STRIKING IT RICH: Golf in the Kingdom with Generals, Patients and Pros’’. It is a story about playing on the pro golf tour after not playing golf for 30 years. I ended up playing for seven years and winning twice while working as a full time surgeon in Cambodia doing reconstructive surgery on these children. Enter my name on and you can read all about it. But if you don’t like golf, don’t buy it!
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After sanding down the prosthesis, it was a perfect fit.
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 Here is how it happened: The cornea has 8 layers of cells on top of it. Her eyeballs were burned by the acid and were as black as charcoal.. Over the course of the month the top 7 layers sloughed off to expose the basement membrane which regenerated the new layers. The day she was able to see was the day the last burned layer sloughed off to reveal the new cornea! The drops kept the new cells of the cornea viable during this process as they would have dried out and died because there was no upper lid blink to keep them moist… It worked!


A month later, scar contractures were keeping her eyes open all the time. I had to release the lids because they couldn’t touch. Then I had to fill the defects so created with skin I harvested from behind her ears. Can you imagine trying to sleep with your eyes open? They get very dry too. So we had to break out the drops again, dropping water into her eyes every few minutes.
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We eventually did a ‘’face lift’’ to remove that nasty scar in front of her ear.
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I’m laying the graft in the bed I created while releasing the lids (so they would touch).
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The skin grafts have lost their arterial supply so I had to put these bolsters on to push them down into the bed where they could get their oxygen by diffusion.
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After a few days, I removed the bolsters..
I fixed this scar too…
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See that look in her eyes? This is what I live for. It says: ‘’You’re going to actually get me through this, I believe you now…’’ Words need not be spoken..


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I had to sew her eyelid shut for another month so it would heal without contracture and function properly. What she went through…
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31 The Z-Plasty

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Fixing a Hole in the Drywall of the SAE House at MIT …
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I actually did it at the same time that I fixed the upper lid..
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She and her fiance scheduled their wedding exactly a year to the day after she was burned. They now have three children.  She is one of the most amazing women I have ever known.
 Here she is about 5 years after our time together.



Sulfuric Acid thrown in her face when she was 16. Look at her chin burned down to the bone. No ear. Skin like dried tree bark.
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I had to borrow this picture from the internet to show how the radial forearm flap is harvested. My patient was similar except we didn’t use the Palmaris Longus tendon that you can see there hanging off the side of the island graft. That paddle is attached to her lungs by way of the radial artery. Please read the article ”Simple in Theory, Complex in Execution’’ located elsewhere on this website.


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Anything else? (Yes..Look at her neck profile.)


Humans tend to notice straight lines more readily than jagged lines. There were no man-made canals on Mars
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Before & After Reconstructive-42 So I broke up the very noticeable line with a z-plasty.I don’t have a dermabrader so, here, I had to use…
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I’m going to have to fix that unbecoming twist of her mouth brought on by the healing radial forearm flap. If I don’t, it‘ll get worse.
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Why did my repair come out so perfectly on this patient?I’ll have to study it carefully to determine why…
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Removing the face leaves only the vectors…
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I’ll draw in the vectors of the healing radial  forearm flap and see where it leads me…
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I’ll re-do this area and make sure the vectors cancel out perfectly this time.
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The line at the interface between the forearm flap and her advancement flap over her chin can be made ‘’invisible’’ by making 6 or 7 z-plasties… Then you will

not be able to notice any difference between the forearm skin and her facial skin. I don’t want to ‘’sand’’ it because the skin over her chin has been stressed

too much already. A dermabrader would be best but I don’t have one. ( A dermabrader is really just a mini z-plasty machine…) Maybe I will wait for a machine to get the best result for her. So for now I have finished…  Please do note how perfectly horizontal is the shadowline between her lips. My creation of using vector cancellation in facial reconstruction was a success…

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See her beauty through the scars… Before & After Reconstructive-54-2
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I am so proud of this.This girl’s life was ruined at age 16 by the acid burn. Now, she is beautiful…She ended up marrying the young man who first brought her to my clinic, asking for help after having taken her to many hugely-funded plastic surgery charities in Phnom Penh who told her there was nothing they could do. They now have a beautiful baby daughter…

This case is also note-worthy on a personal level. I used many techniques and lines of reasoning that cannot be found in any textbook of plastic surgery. It was my first case of this kind and I had nothing to guide me so I had to look inward, to my aesthetic sense for the vision and then apply my understanding of physics and skill as a surgeon to make it a reality. She is so beautiful to me…